Provider Demographics
NPI:1336222322
Name:SUMMERS, JOSHUA GEOFFREY (LIC ACUP)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:GEOFFREY
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:LIC ACUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 COMMONWEALTH AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-4636
Mailing Address - Country:US
Mailing Address - Phone:781-710-5215
Mailing Address - Fax:
Practice Address - Street 1:1112 BOYLSTON ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3660
Practice Address - Country:US
Practice Address - Phone:781-710-5215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222892171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist